Childhood sexual abuse is a common problem. Patients with subacute and nonacute injuries may be treated in the physician's office. Patients with acute injuries are usually best managed in an emergency department where forensic testing can be performed efficiently. Physicians need to know how to appropriately interview children with signs of acute and subacute trauma. The physical examination should be thorough, nontraumatic and well documented. Evidence of inflammation, infection, and acute or healed trauma should be sought. Attention should be paid to sexually transmitted diseases, pregnancy prevention and mental health needs. Coordination with child welfare services, mental health professionals and law enforcement officers is often indicated. Awareness of the various presentations of sexual abuse and familiarity with normal and abnormal genital findings are necessary for the initial evaluation of these children.